Bailey's platelets have been low for the last 3 weeks. Today the vet actually told us a number (before, they didn't seem too/really concerned so we didn't ask). They said a normal range is 170-400 and hers is 45. That seems really freaking low to me.

She's been bleeding lately (the original reasons for our vet visits). In her ear is a growth (skin tagish) that didn't used to bother her. We assumed she scratched it just the right way, caused it to bleed and then the bleeding was causing her to mess with it more. We have an ear drop we've been giving her and are making plans to have it removed. She's also been bleeding from the mouth. We assumed the same thing-scratched herself pretty good and the healing of it is causing her to keep messing with it. Then Friday she was walking around with an arched back. Couldn't lie down and get comfortable-seemed out of sorts. We took her back in, they manipulated her and came to the conclusion that she pulled a muscle-very likely. She broke one of her front feet a while back, and I thought it was possible she jumped on/off our bed favoring that leg and landed bad a pulled a muscle. We give her the generic version of tramadol for that as needed. The vet gave her a shot Friday, and sent us home with muscle relaxers. Her bleeding has almost completely stopped-but they ran the blood test Monday that indicated the 45 on the platelet count.

Austin is the one that got the phone call. He couldn't remember enough of the detail to make me feel comfortable, so he's going to the vet today to talk to them in person...and get a print out of the ($75) test they ran yesterday. Once I have that info I'll share it.

In the mean time, I'll be the one sitting over here trying not to cry at work.

I've been talking with a couple people, researching some links and fa-reaking myself out. So my husband encouraged me to stop, and if information is what I'm looking for then I need to talk directly to the vet. So I have an appointment with him (without Bailey) at 4 today. I have a list of questions (see below).

We haven't given her asprin...but she does get the generic version of tramadol as needed (maybe 3-4 times a month).

The plan for now is to give her prednisone for the next two weeks (no more tramadol or muscle relaxer during this time) and then retest. If I understand it correctly, the prednisone promotes platelet growth because it lessens swelling...the platelets come from the bone marrow-traveling through the joints into the blood, if the joints are swollen the platelets can't come in. The vet keeps mentioning auto immune-but nothing specific. If that's the case, I don't understand the use of pred-if her body is attacking her platelets or her blood-shouldn't we start with stopping that vs creating more platelets/blood for the body to attack?

What are we waiting two weeks and treating with prednisone-I understand that pred will up her platelet count...but don't we want more than that-to understand why this is happening?

How was the most recent test we had done different than the first two, and how does it differ from further testing?

What could be the underlying cause? How do we determine that? What are the "kind of expensive tests" that were mentioned earlier and how do they help? Why can't we do them now? What information will they provide?

Tick borne disease tests?

Panels for any immune-mediated diseases?

Toxins/infections a possibility?

Rads? Ultrasound? Bone marrow biopsy?

Could it be these: Ehrlichiosis, Rocky Mountain Spotter Feaver, or Pancreatits

Should we see a specialist-who is recommended?

Related to hemangiosarcoma?

Should we change her food (less the protein)?

Is the generic version of tramadol an NSAID?

Do we need to taper her off of the prednisone?

Mentioned if the platelets were in the low 30s or 20s we'd start to see symptoms-symptoms for what, what do they indicate other than low platelets?

More info wanted on thrombocytopenia.

Should we be checking her spleen?

I know it seems like a lot...but some of the follow up question could be answered by the questions that precede them.

Do you guys have any other suggested questions?

Here are her test results from Monday:

The only things that look off to me are the platelets (obviously), and then the RBC, Hemoglobin and the Hematocrit look a little high. Which means:

•RBC is an abbreviation for red blood cell count. These cells are responsible for transporting oxygen throughout the body. Oxygen is used as fuel for the body and is very important. High red blood cell numbers usually indicate dehydration but can also indicate uncommon diseases that cause an excess production of red blood cells from the bone marrow.

•HGB is an abbreviation for hemoglobin. This molecule is responsible for binding and releasing oxygen onto the red blood cells. Without hemoglobin, oxygen cannot be transported. High levels of hemoglobin usually indicate high red blood cell counts and dehydration.

•HCT is an abbreviation for hematocrit. The hematocrit is a calculated percentage of red blood cells in the circulation. It gives similar information to the red blood cell count but the value is expressed as a percentage. The other part of the blood is serum, containing enzymes, proteins, electrolytes, etc. High hematocrits indicate dehydration or rare bone marrow disorders resulting in increased red blood cell production.

So it sounds like dehydration. Which obviously isn't good, but it's not terrible either.

There are different reasons that a dog can have thrombocytopenia, which just means low platelets.

A common reason is that the immune system starts attacking and killing the platelets. This disease is usually referred to as ITP, idiopathic thrombocytopenia purpura meaning we don't know why but the immune system is killing platelets. The steroids are given to suppress the immune system so that it doesn't attack the platelets anymore - which is exactly what you were thinking was the most important place to start. I think the part about the swelling and the joints was a miscommunication... there is a disease where the immune system attacks the joints (IMPA) but unless she also has that disease, that part may have been a mixup.

Let us know how it goes with the vet, hopefully everything starts making more sense tomorrow! And if it doesn't make sense or if you feel like something's not right, don't hesitate to see a specialist for a second opinion (would probably start with an Internal Medicine specialist). I'll be thinking good platelet thoughts for Bailey!

Oh, and to answer your question about tramadol (brand or generic), it is an opiod not an NSAID.

*Copy and pasted from my post over at PBC (with minor changes/updates)*

I feel MUCH better after talking to my vet. Still not 100% comfortable...but less-freakingoutOMGisshegoingtodie.

Here are the list of questions I have for the Dr: (and I called to set aside some time with him-I don't want to take away from other patients that are there)

Why are we waiting two weeks and treating with prednisone-I understand that pred will up her platelet count...but don't we want more than that-to understand why this is happening?Dr Rubio explained that the primary reason for treating with prednisone is that it helps to prevent the body from attacking its own cells. Platelets can take 6 to 8 days to be created/replenish and that's why we're waiting two weeks. The fact that pred can also reduce swelling is just an added bonus

How was the most recent test we had done different than the first two, and how does it differ from further testing? The first two tests we had done were "in house", the last one was sent out. Further testing would be more specific-currently he's interested in a tick serology test (when we go back in two weeks).

What could be the underlying cause? How do we determine that? What are the "kind of expensive tests" that were mentioned earlier and how do they help? Why can't we do them now? What information will they provide? He told me two things-auto immune thrombocytopenia and ehrlichia. The ehrlichia is a tick disease. We're waiting because Bailey doesn't appear to be too sick and he didn't think what she presented with required such an aggressive approach (thanks for saving me a couple bucks!-you know how some vets can be)

Rads? Ultrasound? Bone marrow biopsy? Not at this time-no need to be this aggressive

Could it be these: Ehrlichiosis, Rocky Mountain Spotter Fever, or Pancreatitis Happy to know I was generally in the same area of thought as the vet. RMSP isn't common here and with Pancreatitis she'd be throwing up. (we've had none) I also asked about SLE (lupus) and he said no-she'd appear to be much sicker than she is.

Should we see a specialist-who is recommended? He provided information for an internal medicine doctor in our area, said he'd fax over all of our info to him and encouraged me to go to him if it would make me happy. Promised he wouldn't be offended in any way/shape/form. The IM doctor is about $150 to walk in the door. Bailey's blood work can't be older than a month (otherwise he'll want to run his own tests-which are "expensive") He will strongly suggest following the direction of my original vet-per the phone receptionist. It doesn't take long to get in to see him (I was worried his appointments would be like a month out). --from some local friends I've heard he's more businessy and doesn't have much bedside manner-but excels at what he does. So while (if we decide to see him) he may not give us a warm fuzzy-Bailey will be in good hands.

Related to hemangiosarcoma?Dr. Rubio does not believe the auto-immune stuff has anything to do with the cancer she had. She just happened to have both happen to her.

Should we change her food (less the protein)?He said there is no need for this. Additionally Dr. Oliver told me we shouldn't lessen her protein intake right now because we need it to build muscle/tissue. But she said I could lessen it...another way (I forgot what she said, but) basically I'd simply give her less food.

Is the generic version of tramadol an NSAID? Yes AND not only should she not be getting her muscle relaxer while on the pred-she also should not be getting the tramadol. It works like aspirin in that it thins the blood-that's the opposite of what we want right now.PITsb, I think you're right-about my being misinformed. As it turns out what we were using ad hoc for Bailey was not the generic version of Tramadol...it was carprofen-which still can't be used while she's on the prednisone...but as it turns out she can have the tramadol.

Do we need to taper her off of the prednisone?I forgot to ask about this Dr. Oliver (the vet I spoke to today) said that the prescription Dr. Rubio wrote did not indicate to wean Bailey off of the medicine, which leads her to believe that when we're scheduled to go back in two weeks-he'll be giving us some more. We won't know if we need to wean her off of that prescription until they rerun tests. She explained the use of prednisone as being similar to chemotherapy-we're suppressing her immune system. Trying to stop it from attacking itself.

Mentioned if the platelets were in the low 30s or 20s we'd start to see symptoms-symptoms for what, what do they indicate other than low platelets?The symptoms would be bleeding from any of her orifices (nose, eyes, butt...blood in the poop or pee) or any kind of bruising. She could bruise from something as simple as laying on a hard ground-which didn't make me feel great because we have hard wood floors and tile...but we checked her over last night and she looks ok. We should prevent her from doing anything that could cause bleeding-that means no digging-which she's totally bummed about. He did okay her to chew on bones and he left walks and car rides up to our discretion. She chewed a bone last night...it looked a little pinkish so I took it away. We need to keep her from jumping, falling or bumping into things (bruising) as well.

More info wanted on thrombocytopenia. He didn't really provide any more info on this, except to say this is part of what he thinks is wrong. I don't mind looking it up again though. I looked at so much stuff over the last couple of days that it all sort of runs together...it'll be good to narrow the info down. The vet I talked to today gave me veterianarypartner.com and a source reference, encouraged me to look up IMT and ehrlichia

Should we be checking her spleen?No, there is no reason to at this time. And if it was her spleen-spleenectomies are not very successful in dogs.

I think part of the reason he thinks it has to do with tick borne disease is because we treated our dogs with comfortis for a long time. We never found a tick on Bailey (that I can remember) but that doesn't mean she wasn't affected by one. (it's not a big problem where we live) I also asked him about her shaking because the night before I talked to him it was bed time and she was shivering. I covered her up thinking she was cold and she continued to shake. I cuddled with her and she typically doesn't allow that, but she stopped shaking. I figured either she was cold and the blanket didn't cut it, or she was in pain/uncomfortable and me being there helped. He said that a side effect of prednisone can be shaking. After reading a little bit...I'm wondering if maybe her dosage is too high. Additionally when I rubbed her goodbye today I got a handful of fur. I know pred can cause skin issues...I just didn't think it'd happen so quickly. Dr. Oliver suggested not lowering her dosage and just accepting shaking as a side effect for right now because upping that platelet count is critical. She said she'd speak to a specialist about the hair loss...she also had pulled Bailey's records up while we were talking and mentioned one of our previous vet visits-where the tips of Bailey's ears had gotten a little swollen. It's form of swollen blood vessels and can also be an indicator of the IMT/ehrlichia.

I feel much better, and he was very nice (and calming) to me. He told me if I have any more questions, questions about the stuff we've already gone over-or anything at all-to please feel free to call him. He has no problem going over the info again and again. He understands it's a lot to take in and since this isn't my field of expertise...I'm not really knowledgeable...it's probably the equivalent of when someone comes here telling us they have a pure bred Red Nose GrCH, etc...etc....the words they're saying mean something-just not what they think...there's no actual knowledge behinded, it's just being parroted

We are doubling her current antibiotic-which we started incase it was erhlichia. I don't know anything about lyme...so I'm researching now. But I think I feel good about this diagnosis. It's treatable, if there are long lasting side effects from it (stiff joints) we can manage that.

The vet visit went very well yesterday! Her platelets are up to 410! I'm so stoked. I could have hugged Dr. Rubio when he told us. He wants to keep her on the prednisone for another two weeks and we'll start lowering it then (assuming the platelets stay level).

The only thing that was a little weird was-she lost two pounds. I thought she definitely gained weight. We've trying to be mindful but she's been getting more treats and substitute treats (carrots and green beans). So the only thing I can think of is she lost muscle mass and gained fat.

We took Bailey in on Saturday and she had lost another 2.5 pounds. It's really starting to show Her platelets were lower than last time but still within the "normal" range. (Before they were at 410-which we were stoked about-on Saturday they were at 296) Her WBC is down from 7.91 to 5.37 which is on the verge of being low. Currently the vet isn't too concerned with that, but is very concerned about her weight loss. We opted for x-rays-she's been looking very....sway back is the best way I can describe it. And I guess if she had a tumor we'd be able to see it. We are beginning the process of working her off of the prednisone. She's down from one pill twice a day to half a pill twice a day. She also has a tooth that needs to be removed because the pulp is showing, but Dr. Rubio is not comfortable putting her under right now. He said sometimes the pulp will die/retract and then it isn't painful anymore...but it's a shot in the dark. As soon as he showed it to us and touched it-she recoiled, so I know it hurts it's crazy because Friday night she was in the bone zone. But I guess-maybe that's when she did it. Poor girl can't catch a break. She has a little raw spot on one of her pads too.

She went in for x-rays today and is down another pound. They can not find a reason for her weight loss. The x-rays-from what the Dr. could see didn't indicate much. She has a little bit of calcium build up on her spine near her hips, but to the Dr. it looks like regular arthritis type build up. He's sending the x-rays out to the specialist. He wants us to keep feeding her what we are, and add wet food.

I'm considering satin balls...but I'm concerned because through trial and error we've found that she's allergic to beef-and if I remember correctly-that's what satin balls are made from...but I wonder if she's only allergic to beef as it is in dog food. Is that possible? Could there be a difference in giving her an actual steak versus beef based dog food? I also wonder if making the satin balls with chicken would be as beneficial-so I'm off to do some research.

The other possibilites I'm thinking about are-maybe her food isn't compatible with the medicine she's on...if we switch it-maybe that'll help...or once she's off the medicine it'll get better...but I don't even know if that's a reasonable thought.

I guess if it were me I would try some canned food first along with her food, then you can get salmon or duck or whatever kind you think she can tolerate well. I wonder if a canine probiotic might help? Sorry she has all this stuff going on,